Hospice care provides comfort-focused, quality-of-life care for individuals facing a life-limiting illness. This approach shifts the goal from curing the illness to managing symptoms and providing emotional and spiritual support. Hospice care does not involve chronological “stages” that a patient moves through sequentially, but rather uses four distinct “Levels of Care” mandated by Medicare. These levels are based entirely on a patient’s immediate medical needs and ensure the intensity of care can be adjusted quickly to maintain comfort.
Eligibility Requirements for Hospice Care
A patient must meet two main criteria to be eligible for hospice services. The first requirement is a clinical certification that the patient is terminally ill, meaning their prognosis is six months or less if the disease runs its expected course. This certification must be made by both the patient’s attending physician and the hospice medical director.
Physicians often use clinical indicators like significant weight loss, frequent hospitalizations, or a decline in functional ability to support the six-month prognosis. The second requirement involves the patient’s personal choice to elect the hospice benefit. This decision means the individual chooses to forgo curative treatments for the terminal illness and focus entirely on comfort and symptom management, a philosophy known as palliative care.
Understanding the Four Levels of Hospice Care
The four Levels of Hospice Care ensure that a patient’s needs are met as their condition changes, allowing the care setting and intensity to be flexible. The level of care can fluctuate daily or weekly, preventing the need for a patient to move through fixed “stages.” All Medicare-certified hospice providers must be able to offer all four of these levels.
Routine Home Care (RHC)
Routine Home Care is the most common level of service and is delivered wherever the patient resides, which may be a private home, assisted living facility, or nursing home. This level covers intermittent visits from the hospice team, including nurses, aides, social workers, and chaplains, to manage symptoms and provide support. The patient is generally considered stable, with symptoms adequately controlled by the current care plan.
Continuous Home Care (CHC)
Continuous Home Care, sometimes called crisis care, is a short-term, intensive level of service provided in the patient’s home. This level is implemented when a patient experiences a medical crisis, such as uncontrollable pain or acute symptom exacerbation, that cannot be managed by the primary caregiver or through routine visits. It requires continuous skilled nursing observation and care for a minimum of eight hours and up to 24 hours to achieve symptom stability.
Inpatient Respite Care (IRC)
Inpatient Respite Care is uniquely focused on the well-being of the primary caregiver rather than the patient’s immediate medical crisis. This level allows the patient to be temporarily transferred to a facility, such as a hospital or dedicated hospice unit, for up to five consecutive days. The goal is to provide the family caregiver with necessary rest and relief to prevent burnout.
General Inpatient Care (GIP)
General Inpatient Care is necessary when a patient’s symptoms, such as severe pain, respiratory distress, or persistent nausea, become so acute that they cannot be managed at home. The care is provided in a dedicated hospice inpatient facility, a hospital, or a skilled nursing facility with 24-hour nursing supervision. GIP aims to achieve rapid stabilization of acute symptoms so the patient can return to the Routine Home Care level as quickly as possible.
Structure of the Medicare Hospice Benefit Period
The timeline for hospice coverage is structured into defined benefit periods rather than a single, continuous enrollment. The initial enrollment consists of two separate 90-day periods, followed by an unlimited number of subsequent 60-day periods. Coverage continues as long as the patient remains eligible.
At the start of each new benefit period, the patient’s eligibility must be recertified to confirm the six-month or less prognosis. For the third benefit period and all subsequent 60-day periods, a hospice physician or nurse practitioner must conduct a face-to-face encounter with the patient. This encounter documents clinical findings that support the continued terminal prognosis.